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Save the lives of many cases of severe dengue shock in infants

Recently, City Children’s Hospital received 4 cases of infants under 12 months suffering from severe dengue. The first school was DBN, 8 months old, female, living in Dong Thap, hospitalized in a state of shock. Taking the medical history, the child had a high fever for 3 consecutive days, cough and runny nose, and on the 4th day, the child had reduced fever and vomited 3 times with brown discharge, distended abdomen, and bleeding spots on the skin, so the family took the child to the hospital. local hospital.

Here, the child was lethargic, fussy, light radial pulse, cool extremities, clamped blood pressure 80/60mmHg, petechiae in limbs, abdomen. The test results showed that the NS1 antigen rapid test was positive, the red blood cell volume was reduced to 25% (normally only 28-35%), the platelets were 23000/mm3 (normally 200000-300000/mm3), and the liver enzymes increased. high > 6000 units/L (normal AST/ALT < 40 units/L).

Immediately the child was diagnosed with severe dengue shock and received intensive anti-shock treatment with electrolyte solutions, then changed to macromolecular solution, blood transfusion, then transferred to City Children’s Hospital, continued treatment. anti-shock therapy, blood transfusion, liver support treatment. The child’s hemodynamic status, liver damage improved, but on the 7th and 8th day, the child had a fever again, blood tests showed that the child showed a decrease in 3 blood cell lines, increased triglycerides, ferritin, .. is a manifestation of the disease. Hemophagocytic syndrome after dengue fever, the child was consulted by a hematologist for further treatment and recovered after nearly 3 weeks of treatment.

Case 2 is an 11-month-old HGB child, male, living in Tien Giang. History recorded that the child had a high fever for 4 days continuously, diarrhea 5-6 times with yellow liquid stools, went to a private clinic to diagnose infectious diarrhea, took drugs of unknown type, on the 5th day, the child’s fever subsided, lethargy, and diarrhea. liquid, green stools, cold hands and feet, so the family took the child to a local hospital, noted that the child was lethargic, fussy, light radiating pulse, cool extremities, clamping blood pressure 85/65mmHg, diagnosed with septic shock, infection septicemia from the gastrointestinal tract, antibiotic treatment, anti-shock fluids. transferred to the City Children’s Hospital.

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Here, the child continued to receive anti-shock fluids, the test showed that the rapid test NS1 antigen was positive, the red blood cell volume decreased by 40% (normally only 28-35%), the platelets 18000/mm3 (normally 200000- 300000/mm3), elevated liver enzymes > 7000 units/L (normal AST/ALT < 40 units/L), the child's hemodynamic status improves but liver enzymes are still elevated > 5000 units/L, so supportive treatment should be given. liver and infusion of the liver detoxifier N acetyl cysteine. Results after nearly 1 week of treatment, the child’s condition gradually improved, his condition, liver enzymes returned to normal.

School 3 and 4 are 9-month-old PLM children, female, living in District 12, and 7-month-old NTH child, female, living in Long An, both of them only have an average mild fever of 38-38.5 degrees Celsius, cough. runny nose for 4 days, a private doctor diagnosed upper respiratory infection, antibiotic treatment to reduce fever, reduce cough until day 5, the young family member cried and stopped breastfeeding, so they were admitted to the City Children’s Hospital.

Here, the doctors performed diagnostic tests for the children with dengue fever thanks to the rapid test NS1 antigen and antibody were positive. They were treated with anti-shock fluids according to the protocol. The animals were well after 3 days of treatment and discharged from the hospital.

Thus, parents should note that dengue fever can affect infants, but children may have atypical manifestations such as mild, intermittent fever with cough, runny nose, sneezing, or diarrhea, vomiting, etc. think with respiratory, digestive or infectious diseases…so it is necessary to take the child to a medical facility with a pediatric specialty for examination and accurate diagnosis for appropriate treatment for the child.

  Time-out

Doctor 2 Nguyen Minh Tien
City Children’s Hospital

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